Two case reports of smoking behavior changes after self-initiated e-cigarette use and tobacco smoking cessation

Objective: The purpose of this report is to increase the clinician's understanding of electronic nicotine-delivery systems (ENDS) by describing similar observations of two subjects "forgetting" to use self-initiated ENDS. Observations: A 51 year old Caucasian female with severe persistent mental illness reported continued tobacco abstinence and "forgetting" to use the ENDS at week 24 and continued tobacco abstinence beyond week 52. Also, a 42 year old Caucasian healthy male with continued tobacco abstinence and "forgetting" to use the ENDS after approximately 14 weeks remained abstinent of conventional cigarettes beyond 52 weeks. Discussion: ENDS do not continually produce smoke like conventional cigarettes; the absence of continuous smoke may not compel the user to continue inhaling. ENDS differ from conventional cigarettes because of the on-off feature of the device, requiring the user to inhale to activate a battery-powered nicotine delivery system (atomizer). Conclusion: Additional research is needed to verify the impact of ENDS on smoking behavior in smoking cessation. Clinicians should monitor but not yet recommend the initial use of ENDS for smoking cessation until the FDA imposes regulations on ENDS companies to ensure consistency of labeling of ingredient amounts and the overall safety of the products.